Abstract: SA-PO803

Epoetin Alfa and Darbepoetin Alfa: A Cross-Sectional Study Comparing Doses According to Administration Intervals

Session Information

Category: Dialysis

  • 605 Dialysis: Anemia and Iron Metabolism

Authors

  • Dupuis, Marie-Eve, Université de Montréal, Montréal, Quebec, Canada
  • Lamarche, Caroline, None, Montreal, Quebec, Canada
  • Bell, Robert Zoel, Centre de recherche Hopital Maisonneuve-Rosemont, St. Lambert, Quebec, Canada
  • Desforges, Katherine, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada
  • Lepage, Laurence, Hopital Maisonneuve Rosemont, Montreal, Quebec, Canada
  • Pichette, Vincent, Université de Montréal, Montréal, Quebec, Canada
  • Lafrance, Jean-Philippe, None, Montreal, Quebec, Canada
  • Vallee, Michel, None, Montreal, Quebec, Canada
Background

Anemia is a common problem among patients with chronic kidney disease. Erythropoiesis stimulating agents (ESA) are frequently used to maintain haemoglobin between 95-115 g/L. Multiple studies suggest that longer intervals than those recommended in the product monographs of these ESA can be effective. Most of these studies were done in non dialysis patients. Fewer studies were done with population in hemodialysis, peritoneal dialysis and in transplanted patients.

Methods

In this retrospective, single center, cross-sectional study, we compared the dose, reported in IU/kg/week, between groups defined by the interval at which patients received ESA (more than once a week (G0), once a week (G1), once every other week (G2), once every three weeks (G3), once every 4 weeks (G4) and once every more than 4 weeks (G5). Charts of all patients receiving an ASE at a stable dose for at least three months and followed in either the pre-dialysis, hemodialysis, peritoneal dialysis and transplant clinic were reviewed.

Results

Five hundred and ninety four patients were included. One hundred and twenty-two patients (22%) were on epoetin alfa and 462 (78%) were on darbepoetin alfa. The mean dose/kg/week was less when a longer interval was used: the mean dose/kg/week)
was 247 in G0, 195 in G1, 82 in G3, 67 in G3, 33 in G4 and 28 in G5 (p<0.0001). In the epoetin subgroup, the mean dose/kg/week was 256 in G0, 124 in G1, 52 in G2, 37 in G3, 19 in G4, 17 in G6 (p<0.0001). In the darbepoetin subgroup, the mean dose/kg/week was 162 in G0, 228 in G1, 86 in G2, 71 in G3, 35 in G4, 33 in G5 (P>0.0001).

Conclusion

Doses were significantly lower in the longer interval groups, suggesting that longer intervals are efficient to maintain haemoglobin in the desired target in a large population of patients with chronic kidney disease. The mean dose remained smaller in the longer intervals when comparing both ESA types, however, the mean dose was generally less in the epoetin group compared to the darbepoetin group. A selection bias might explain some of the differences between groups. Nonetheless, using longer intervals seem possible in a significant number of patients. Since longer intervals are more acceptable to patients and are more cost effective, this approach might be favourable.

Funding

  • Clinical Revenue Support